Hands on| Volume 5, ISSUE 11, P1625-1630, November 2008

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Ablation above the semilunar valves: When, why, and how? Part II

  • Mahmoud Suleiman
    Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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  • Samuel J. Asirvatham
    Address reprint requests and correspondence: Samuel J. Asirvatham, M.D., Division of Cardiovascular Diseases, Associate Professor of Medicine, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, Minnesota 55905
    Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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      In this two-part series on arrhythmias occurring above the semilunar valve, we discuss the relevant underlying anatomy and the technique for mapping and ablation above the aortic and pulmonic valve. In part I, we focused on ventricular arrhythmias, and in this paper (part II), we discuss the anatomy and present knowledge of the substrate mapped and ablated above the aortic valve for atrial tachycardia in certain unusual accessory pathways. The background anatomy of the aortic valve has been discussed in part I of this series, to which the reader is referred. Here we discuss the detailed anatomy of the aortic cusps relevant for atrial tachycardia and atrioventricular bypass tracts. Representative cases of these supravalvar arrhythmias are presented, and an approach for safe and effective ablation above the aortic valve to eliminate atrial tachycardia and bypass tracts in this location is then outlined.


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